Very-low-dose combination: a first-line choice for the treatment of hypertension?

Waeber, Bernard

doi:10.1097/00004872-200306003-00002

Cited by 13 publications

(11 citation statements)

References 63 publications

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“…The combination used in STRATHE of the ACE inhibitor perindopril and the diuretic indapamide is particularly justified according to theoretical and experimental evidence. 11 The diuretic stimulates the activity of the renin-angiotensin-aldosterone system (which may induce hypokalaemia), while the ACE inhibitor blocks this system. This means that the antihypertensive effect of the diuretic is enhanced by the action of the ACE inhibitor, and that lower doses of the two drugs are required to normalise blood pressure.…”

Section: Discussionmentioning

confidence: 99%

Managing hypertension: a question of STRATHE

Zannad

2005

J Hum Hypertens

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Current international guidelines recommend the use of therapeutic strategies with proven efficacy in the management of hypertension to achieve a target blood pressure of o140/90 mmHg. After lifestyle intervention, they endorse three different management strategies: (i) first-line use of a low-dose combination of two agents from different antihypertensive classes, with the option of doubling the dose of the combination; (ii) use of a sequential monotherapy strategy, initiating with one antihypertensive to be replaced by another one from a different class, if necessary; and (iii) a stepped care strategy, initiating with one antihypertensive, and increasing the dose or adding another agent from a different class, if necessary. The objective of the STRAtegies of Treatment in Hypertension: Evaluation (STRATHE) study was to compare the efficacy and tolerability of these three treatment strategies in patients with uncomplicated essential hypertension (n ¼ 533). In all, 62% of the patients in the low-dose combination group were normalised (o140/90 mmHg), compared with 49% of the sequential monotherapy group (P ¼ 0.01) and 47% of the stepped-care group (P ¼ 0.005). The percentage of patients achieving normalisation without experiencing drug-related adverse events was also significantly higher in the low-dose combination group (56%) than in the sequential monotherapy (42%, P ¼ 0.001) and stepped-care groups (42%, P ¼ 0.004), consistent with the observation that the reduced dosage of the antihypertensive agents in such preparations translates into improved acceptability. The results of STRATHE provide further support for an antihypertensive management strategy involving the low-dose combination of perindopril (2 mg) and indapamide (0.625 mg).

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Section: Discussionmentioning

confidence: 99%

Managing hypertension: a question of STRATHE

Zannad

2005

J Hum Hypertens

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“…An effective fixed-dose combination, apart from improving efficacy and decreasing the incidence of adverse effects, offers additional practical advantages such as simplification of medication schedules improving thereby persistence in taking drugs and fewer office visits that reduce the costs to the health care system [47,48]. Recent guidelines recommend that fixed-dose combinations should be preferred in order to reduce prescription costs and improve patients' compliance [1,2].…”

Section: Choosing the Right Drug Combinationmentioning

confidence: 99%

“…In addition, by combining drugs with different mechanisms and at low doses it is more likely that dose-dependent adverse effects are prevented [47,48]. Thus, it is hoped that this approach has the potential for improvement of blood pressure control and the optimization of patients' compliance.…”

Section: Combination Pharmacotherapy To Initiate Treatmentmentioning

confidence: 99%

Combination pharmacotherapy in hypertension

Stergiou

2006

Int Urol Nephrol

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Combination pharmacotherapy with two or more drugs is required in order to reach the currently recommended blood pressure goals in the majority of hypertensive patients, particularly those with a goal of <130/80 mm Hg. Further to the potentiation of the antihypertensive effects, benefits of combination therapy include the potential of fewer adverse affects and of improvement of patients' compliance. Current guidelines recommend that combination pharmacotherapy might also be considered as initial treatment in patients with significant elevation of blood pressure and evidence of complications. Several effective and well-tolerated antihypertensive drug classes available today offer multiple options for combination therapy. The choice of antihypertensive agents should be made on the basis of current recommendations regarding first line drugs and compelling indications. Specific drug combinations might have additional beneficial or detrimental long-term metabolic effects, beyond their effects on blood pressure. However, more outcome data comparing antihypertensive drug combinations are required. The implementation of an intensive up-titration treatment strategy, together with a systematic use of full doses of multiple drug combinations, is expected to achieve optimal blood pressure control in the vast majority of hypertensive patients.

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“…This is related to the fact that the multiple interference with pressor systems resulting from the coadministration of two or more classes of agents is more likely to be efficacious given the multifactorial nature of essential hypertension. Also, combination therapy serves to countervail the counterregulatory mechanisms that are triggered whenever pharmacologic intervention is initiated and that act to limit the efficacy of the antihypertensive medication [5][6][7][8][9].…”

Section: Improved Antihypertensive Efficacymentioning

confidence: 99%

“…Special attention will be paid to the usefulness of fixed-dose combinations. The clinical acceptance of such combinations is growing rapidly, not only as second-line, but also as first-line therapy [5][6][7][8][9]. Focus will be given to the evidence that low-dose combination therapies are valuable tools for the initiation of antihypertensive treatment.…”

Section: Introductionmentioning

confidence: 99%

Fixed low-dose combination therapy for hypertension

Waeber¹

2002

Curr Hypertens Rep

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Despite the availability of various classes of antihypertensive agents that lower blood pressure by different primary actions, the treatment of hypertension remains a difficult task. Essential hypertension has a highly heterogeneous character, so that monotherapies are often not sufficient to normalize blood pressure. This is especially true since the goal of treatment is currently to normalize both systolic and diastolic blood pressure. By combining medications acting by different mechanisms, it is possible to gain considerably in terms of antihypertensive efficacy because of synergistic impacts on the cardiovascular system. Furthermore, low doses of antihypertensive agents are generally sufficient when used in combination, which accounts for the excellent tolerability of combination products. Fixed low-dose combinations are very useful tools for treating hypertensive patients. Because of their simplicity of use, and the fact that they improve the blood pressure response rate while minimizing the incidence of adverse effects, such combinations are increasingly being considered as suitable for both second-line and first-line therapy.

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Very-low-dose combination: a first-line choice for the treatment of hypertension?

Cited by 13 publications

References 63 publications

Managing hypertension: a question of STRATHE

Managing hypertension: a question of STRATHE

Combination pharmacotherapy in hypertension

Fixed low-dose combination therapy for hypertension

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